Long-term follow-up of redo pull-through procedures for Hirschsprung's disease: Efficacy of the endorectal pull-through

Background/Purpose: The purpose of this study was to review the authors' 25 -year experience with redo pull-through procedures for Hirschsprung's disea se including surgical technique and long-term outcome. Methods: From 1974 to now, over 325 patients with Hirschsprung's disease ha ve been treated at C.S. Mott Children's Hospital, This includes 30 patients referred after an unsuccessful pull-through at another hospital and 2 pati ents with an unsuccessful pull-through from C.S, Mott. All redo pull-throug hs (n = 19) were performed in these patients, and their clinical courses ar e reviewed. Results: Twelve patients required reoperation secondary to a mechanical pro blem with their first pull-through. The other 7 patients had evidence of re sidual segments of dilated colon leading to functional failure of their ini tial operation including 5 patients with documented aganglionic bowel prese nt at the second pull-through. Ten of the patients requiring reoperation in itially had an endorectal pull-through (ERPT), 5 had a Duhamel procedure, 3 had a Swenson procedure, and 1 had a Rehbein procedure. Choice of revision was an ERPT in 8 patients in whom an adequate rectal cuff could be develop ed. Additional redo procedures included a Duhamel in 8 patients and a Swens on in 3 patients. Follow-up ranges from 3 months to 23 years (mean, 13.8 ye ars). There were no deaths in the series, and 1 patient required a third pu ll-through. All patients who are not neurologically impaired and are over a ge 3 are continent except one (94%). Stools per day range from 1 to 10 (mea n, 3.2). Conclusions: Redo pull-through operations for Hirschsprung's disease appear to be as effective as primary procedures in terms of continence and stooli ng frequency. Distinct from other series, we found an ERPT to be the proced ure of choice if an adequate rectal cuff was present. Copyright (C) 2000 by W.B. Saunders Company.